CurrentCentenePolicy CC.PP.206

Skilled Nursing Facility Leveling (Payment Policy)

Defines reimbursement requirements for skilled nursing facility (SNF) levels of care (levels 1–5 where applicable) for Centene-affiliated health plans and the services that must be provided to support each level.

Policy Summary

PayerCentene

PolicySkilled Nursing Facility Leveling (Payment Policy)

Policy CodePolicy CC.PP.206

Change TypeAnnual review / minor edits

Effective Date

Next Review Date

Key ActionProviders must report the SNF level of care that reflects services performed and meet the specified skilled nursing and/or therapy hour thresholds for the reported level.

SourceLink

POLICY UPDATE CHANGES

Updated header to reflect that policy is a payment policy.

Annual review with minor rewording in Background with no impact on criteria; references reviewed and updated.

Payment rules only transitioned from the retired CP.MP.206 SNF Facility Leveling.

Levels 1-4Defined levels of care in Section I

Levels 1-5Defined levels of care in Section II

1 listHigh-cost drug list entries

CPT/HCPCSCoding guidance included

Medicare manual

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

SNF Level Payment Criteria

Payment criteria by SNF level

To be reimbursed for an SNF level of care, providers must meet the specified skilled nursing and/or skilled therapy time criteria and, for highest levels, demonstrate high‑acuity conditions or administration of a listed high‑cost drug.

ALL of the following

ANY of the following
- Skilled nursing up to 4 hours per day, 7 days per week
- OR skilled therapy 1 to 2 hours per day, at least 5 days per week

ALL of the following

ANY of the following
- Skilled nursing at least 4 hours per day, 7 days per week
- OR skilled therapy at least 2 hours per day, at least 5 days per week

ALL of the following

ALL of the following
- Skilled nursing for more than 4 hours per day, 7 days per week
- AND skilled therapy for at least 3 hours per day, at least 5 days per week

ALL of the following

ALL of the following
- Skilled nursing for more than 4 hours per day, 7 days per week
ANY of the following
- Patient requires Level 4 – Intensive Care Services due to high acuity such as catastrophic multiple traumas, severe head injury or CVA, stabilized spinal cord injury, or ventilator dependence (weanable or non‑weanable)
- OR administration of a high‑cost drug listed in the policy

ALL of the following

ANY of the following
- Skilled nursing required for more than 4 hours per day, 7 days per week
- OR administration of a high‑cost drug listed in the policy

ALL of the following

Administration of a listed high‑cost drug may support payment at Level 4 or Level 5; examples of listed drugs are provided in the policy (see High‑Cost Drug List).

ALL of the following

Facilities must report the SNF level of care that reflects services performed; reimbursement is subject to plan contract terms and state/federal requirements.

CPT / Therapy Codes and Time Thresholds

Referenced CPT/therapy codesCPT

99304-99306	Initial nursing facility care (levels by medical decision making/time thresholds).
99307-99310	Subsequent nursing facility care (time thresholds per level).
99315-99316	Nursing facility discharge management.
99318	Annual nursing facility assessment.
92507-92526,92597,92609	Speech therapy evaluation and treatment codes listed.
97161-97168,97532-97537,97542,97760-97762	Physical/occupational therapy evaluation and treatment, orthotic/prosthetic training codes.

Skilled nursing/therapy time thresholds by level (summary)

Level 1 (Rev Code 191)Skilled nursing up to 4 hours per day, 7 days per week OR skilled therapy 1–2 hours per day, at least 5 days per week.

Level 2 (Rev Code 192)Skilled nursing at least 4 hours per day, 7 days per week OR skilled therapy at least 2 hours per day, at least 5 days per week.

Level 3 (Rev Code 193)Skilled nursing for more than 4 hours per day, 7 days per week AND skilled therapy at least 3 hours per day, at least 5 days per week.

Level 4 (Rev Code 194)Skilled nursing for more than 4 hours per day, 7 days per week AND patient requires high‑acuity/intensive care (examples: catastrophic multiple traumas; severe head injury or CVA; stabilized spinal cord injury; weanable or non‑weanable ventilator dependence) OR administration of a listed high‑cost drug.

Level 5 (Rev Code 199) — (Section II only)Skilled nursing more than 4 hours per day, 7 days per week OR administration of a listed high‑cost drug (used where Section II levels 1–5 apply).

Reimbursement and Billing Requirements

Billing Rule

Report correct SNF level and meet time/acuity criteria for payment

Providers must report the SNF level of care that accurately reflects the services actually performed. Reimbursement for each level is contingent on meeting the specified skilled nursing and/or skilled therapy time criteria (Levels 1–4 in Section I; Levels 1–5 in Section II where applicable).

Level 1 (Rev Code 191): Skilled nursing up to 4 hours/day, 7 days/week OR skilled therapy 1–2 hours/day, at least 5 days/week.
Level 2 (Rev Code 192): Skilled nursing at least 4 hours/day, 7 days/week OR skilled therapy at least 2 hours/day, at least 5 days/week.
Level 3 (Rev Code 193): Skilled nursing >4 hours/day, 7 days/week AND skilled therapy at least 3 hours/day, at least 5 days/week.
Level 4 (Rev Code 194): Skilled nursing >4 hours/day, 7 days/week AND patient requires high-acuity/intensive care (examples: catastrophic multiple traumas; severe head injury or CVA; stabilized spinal cord injury; weanable/non-weanable ventilator dependence) OR administration of a listed high-cost drug.
Level 5 (Rev Code 199, Section II only): Skilled nursing >4 hours/day, 7 days/week OR administration of a listed high-cost drug (applies where facilities are contracted for Level 5).

Key Terms

Definition — Skilled nursing/rehabilitation

Skilled nursing servicesServices furnished per physician orders that require the skills of qualified nursing personnel (RNs or, where regulation permits, LPNs/VNs) to be performed safely and effectively.

Skilled rehabilitation servicesTherapy services (physical, occupational, speech‑language pathology or audiology) provided by qualified therapists or under their supervision to achieve medically desired results.

When non‑skilled becomes skilledA service ordinarily non‑skilled may be skilled if the patient’s special medical complications or complexity require RN/LPN skills to perform or supervise the service.

Definition — Skilled nursing facility (SNF)

Definition of SNFAn institution (or part of an institution) licensed under state law whose primary focus is to provide skilled nursing care and related services for residents requiring medical or nursing care.